HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -7
Date: ¢2. -/
Permit Number: V
R E C E V
- - ---- --- -- Building Permit Application AUG 2 2 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462`1578 Commercial R2SICIeCltlal /�
PERMIT APPLICATION, FOR: To Select from dropbox, click'arrow at the end of line �hc�tY�rs
POR PO,ED IMI'R®VEMENT L®CA
GTIa1UI:
Address:J yd 4orVtiJ0r)�e411� c�•
Legal Description: Qu etll $ coy-e- V n.
Property Tax ID#: ALI - 70 0/ 000- `7 Lot No.
Site Plan Name: Block No.
Project Name:- fa k-rz' 'f
Setbacks Front Y Back: 1�`/
Right Side: X Left Side:_Y
DE AILED DEQSCR+IPTIO+ (� OF ' `ORK:
-7 (-)If O /7/6 Me
CONSTRUCTION fNFORMATION;
Additionalworktobenerformed un ert is permit-check all appy:
11HVAC Gas Tank Gas Piping _Shutters Windows Doors
— ❑ P g ❑ /
Electric ❑ Plumbing Sprinklers ❑Generator El Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor: '"
Cost of Construction:$ d a VY Utilities: _Sewer D Septic Building Height:
Q1IUN'f R/LESSEE: CONTRACI`OR:
Name L iif1e o_ rr41'1. Name: %�anr✓1af J' c��t
Address: commolictl(?Wll / Company: COaj6 a Zfl.7rf
City: _ C/Cc State: Address: 6AS cf , d1.1
Zip Code: 3 q!2/-/9 Fax: 6,�IV,9 City: F . ere e. State: A(
Phone No. 1 S 7-D�l1p-991 Zip Code: 31/}y9 Fax: T7,g_ , /-F 1.Lr�
E-Mail: Phone No._772_ G/6/ 2//d
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: It C.[,3 11 IS-0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ��
SUPPLEMENTAL CONS RUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: - Address:
City: City:
Zip: Phone:. Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that isgranting-a permit will authorize the pVrrrrit'hb1der'to•608"tiie subjecffructure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undelrgoinga'full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted-on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
_Signature of Owner/Lesse Agent Si ture of Contractor•/License Holder,
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF�GD�
ThefPrgoing instr nient was a knowledged before me The forgoing instrument was acknowledged before me
thisC-t-Sday of 2017 by thiscP-ls day of Aacli 20 by
c"�AS eS k�e left �irto m✓ d't<�/J L
(Na of pe on acknowledging Name of person acknowle g)
(Sign ture of Notary Pub c-State of Florida (tknatui4e of Notary Public-Sate of,Florida)
Personally Known OR Produced Identification�� Personally Known OR Pro uced Identification`
Type of IdQjt i t 33L-Z Type of Identification•.Produced L S/Z.e e Q�
JAGUIJELINE HOADLEY` � '-
°�° , ; Notary Public.-St lorida """"''o JACOUELII �g$pLEY
Commission ?(��c�l Commission No. PaYP�
ommission'#FF 942489 ,� « o ary Public-State of Florida
"= •= Commission# FF 942489
'My Comm-Expires Feb 12,.2020
n.
Bonded through National Notary Assn. fi ';�F oo-o•' YComm. xpires eb 12,2020
."✓` - ° Bonded through National Notary Assn.
Revised 07/15'/2014 y ,
REVIEWS FRONT _ ZONING SUPERVISOR PLANS VEGETATION SEA TURTLEr MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS